Background Up to 40% of Emergency Department attendances could be managed in primary care. In response, policies have led to the introduction of General Practitioner Services in/alongside Emergency Departments in England. Our aim was to capture General Practitioners’ perspectives of the service and their experiences in order to identify factors which may support or hinder General Practitioners working in Emergency Departments.
Methods Qualitative study of 10 case sites where GPs were working in/alongside Emergency Departments at NHS sites in England. Data consisted of 186 direct non-participant observations and 226 semi-structured interviews with 191 health professionals, 42 of which were General Practitioners. This paper reports on a thematic analysis of 42 GP interviews and observations relating to GP practice.
Results Both system issues and individual characteristics influenced how General Practitioners viewed and experienced working within or alongside Emergency Departments. Themes identified were: A different kind of GP; Disillusionment with primary care; New ways of ‘doing’ general practice - portfolio working; A reciprocal relationship; Practical barriers and facilitators; Unintended consequences – impact on primary care. General Practitioners working in Emergency Departments saw personal benefits (flexible and portfolio working; less stressful and more supportive environment than traditional general practice; broadening of skills and experience) and systems benefits (sharing their knowledge and skills with secondary care; taking secondary care skills learned into primary care work; prolonging experienced General Practitioners’ working life and enthusing younger General practitioners). They also identified negative aspects. General Practitioners working in Emergency Departments saw themselves as different to ‘usual’ General Practitioners and were sceptical that a critical mass of General Practitioners willing and able to staff Emergency Departments effectively could be reached and sustained. There were remuneration and practical employment issues such as dysfunctional IT systems and contract/indemnity/insurance issues. General Practitioners felt that the General Practitioner in/alongside Emergency Department role should be supported professionally e.g. by the Royal Colleges. Finally, General Practitioners were concerned that employing General Practitioners in Emergency Departments may have the unintended consequence of depleting primary care general practice.
Conclusion General Practitioners’ perspectives of General Practice Services in or alongside Emergency Departments identify systems and individual benefits and issues which may be used by policy makers and managers when planning and implementing General Practitioner Services in/alongside Emergency Departments.
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